Perimenopause: True or False?

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Menopause is finally getting some of the attention it deserves in the media, but how much do we know about perimenopause, the transitional period before menopause? For many, the answer is: not much. In a National Institutes of Health (NIH) survey of more than 3,000 women between the ages of 40 and 65, half were unaware of the term altogether.¹ Test your own knowledge about perimenopause and maybe learn more by seeing if you know which of the following statements are true and which are false.

1. True or false: For most women, perimenopause begins in their 50s.

False

Perimenopause can begin when we are in our mid-30s and early 40s. Although actual menopause starts when your menstrual period ends and there is no further menstruation for 12 consecutive months, perimenopausal symptoms, such as the slowing down of the body’s production of estrogen and progesterone, can begin while we are still actively menstruating.²

​​​​2. True or false: It takes about one year for most women to go through perimenopause.

False

The NIH reports the average is closer to four years. The symptoms can continue during menopause and up to 10 years after menopause. Because this can be such an extended transition, choosing to see perimenopause as a time of change, not loss, can help us keep our sense of humor and label the symptoms as inconveniences rather than disasters.

3. True or false: Hot flashes and night sweats are the most common signs and symptoms of perimenopause.

True

Hopefully, you’re one of the women who have no physical changes they are aware of during perimenopause, but most can expect hot flashes and night sweats as the body adjusts to hormonal changes. The exact causes of hot flashes and night sweats are still not completely understood but are thought to be related to the changing hormonal influence on the brain’s thermoregulatory center, which controls heat production and loss.

Some other common physical symptoms include heart palpitations, sleeping difficulties, headaches, a slower metabolism and consequential weight gain, vaginal dryness, and decreased libido.

4. True or false: Perimenopause brain fog is real.

True

This one even surprised me. I would have answered "false" until I read recent studies finding that women may experience memory lapses, difficulty concentrating, mood swings, and feeling "out of it" during perimenopause.³ The good news is that for most of us, it’s a temporary side effect as our bodies adjust to the decreased estrogen levels.

5. True or false: Like PMS, perimenopause can mean mood swings and increased emotionality.

True

In the past, these symptoms were often explained as disappointment over diminishing fertility, the impact on family building plans, concern about aging parents, or hearing people your own age described as "middle-aged." In other words, life stress.

Current research finds the psychological symptoms caused by perimenopause are as real as the physical symptoms. Because hormonal fluctuations, particularly the decline in estrogen, can affect neurotransmitters responsible for emotional regulation, there is an increased risk of depression and anxiety during perimenopause.⁴ In fact, last month, University College London released findings that women are 40 percent more likely to experience depression during perimenopause than women who are not experiencing perimenopause.⁵

6. True or false: Not much can be done about perimenopausal symptoms except "grin and bear it."

False

I hope you knew that the answer would be "false." The more you know about perimenopause, the more you can practice strategies for intervention and management.

Here are some science-based suggestions:

• Cognitive-behavioral therapy is recommended for insomnia, depression, and anxiety. It helps you recognize negative thinking and reframe your thoughts to produce more positive feelings and effective coping behavior. This is especially recommended if you are trying to start a family and are dealing with diminished ovarian reserve. This approach usually quickly helps decision-making and coping, and many find that three to eight sessions give them enough skills and strategies to deal with the impact of perimenopause on their fertility journey.
• Meditation and mindfulness can help if you are dealing with depression because they help you stay in the here and now rather than reliving your past with regrets or "pre-living" the future with anticipatory anxiety.
• Stress-management techniques help by stopping, preventing, or using up the adrenaline outflow that can keep you up at night, agitate you during the day, or increase your impatience with anyone who doesn’t do things as quickly or as well as you do. Some stress reducers include yoga, deep-breathing exercises, progressive relaxation, dancing, bike riding, jogging, or even painting a wall. Notice that all are rhythmic. That’s because predictability and knowing what comes next is stress-reducing.
• Lifestyle choices: Did you know that smokers tend to enter menopause an average of two years earlier than nonsmokers, according to the North American Menopause Society? Lifestyle choices make a difference. Eating fruits, vegetables, lean proteins, and whole grains helps reduce fatigue and prevent weight gain as metabolism slows. You may crave carbs because they boost the production of the feel-good hormone serotonin, but the sugars also raise insulin and increase brain fog.⁶ Exercising signals your muscles that they are still needed and gets oxygen to the brain. That doesn’t mean you have to join a gym. All physical activity counts: walking the dog, running after the cat, cleaning the garage, painting a wall, or going up stairs. Aim for the 30/3 rule: 30 minutes of exercise, 3 times a week. Finally, sleep is a natural de-stressor, so skip caffeine, alcohol, and any stimulants before bedtime.
• Hormone Replacement Therapy? HRT generally reduces perimenopausal symptoms but has been associated with concerns about increased risks of breast cancer, heart attack, and blood clots. According to the American Society for Reproductive Medicine, however, the benefits of HRT may outweigh the potential risks unless medical history, age, or family genetics are counter-indications. If you want to know more, speak to your physician about the pros and cons for you.

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As you can see, not everything you read about perimenopause is true, and not all symptoms are universal. Keep checking reliable sources for more research findings, and don’t hesitate to ask your doctors any questions you may have.

To find a therapist, visit the Psychology Today Therapy Directory.